Interdisciplinary Obesity Center, Department of Surgery, Cantonal Hospital St. Gallen, 9400, Rorschach, Switzerland.
Obes Surg. 2012 Sep;22(9):1427-36. doi: 10.1007/s11695-012-0708-y.
Proximal Roux-en Y gastric bypass (RYGB) representing the most frequently performed bariatric procedure yields a weight loss failure rate of around 20 %. In order to reduce failure rates, we established a novel distal RYGB variant characterized by a very long alimentary (Roux) limb and a short common channel. Up to 5 years, follow-up data (complication rates, weight loss, nutritional/metabolic changes) of the first 355 patients (mean ± SD preoperative age, 41.4 ± 10.8 years; BMI, 48.5 ± 11.5 kg/m(2)) who underwent the novel Distal Very Long Roux-en Y Gastric Bypass (DVLRYGB) were analysed. Overall follow-up rate was 98.9 %, mean follow-up time 1.6 ± 1.4 years. Limb lengths were as follows: common channel 76 ± 7 cm, biliopancreatic limb 79 ± 14 cm, and alimentary (Roux) limb 604 ± 99 cm. The operation was performed laparoscopically in 95.2 % of the cases. Thirty-day mortality was zero; major and minor complication rate was 4.5 % and 10.4 %, respectively. Average excess weight loss (EWL) was >74 % 3, 4, and 5 years after the operation and failure rate defined by an EWL < 50 % remained < 6 %. Annually blood measurements revealed a relatively low incidence rate of severe nutritional deficiencies, but mild anaemia and hypoproteinemia were frequently observed. Laparoscopic revision with a proximalization of the lower anastomosis was required in 4 (1.1 %) patients. Data indicate that our DVLRYGB leads to excellent weight loss results. Furthermore, within the setting of a structured multidisciplinary follow-up program, the incidence of severe malnutrition states was relatively low.
近端 Roux-en-Y 胃旁路手术（RYGB）是目前最常进行的减重手术之一，但仍有约 20%的失败率。为了降低失败率，我们建立了一种新型的远端 RYGB 术式，其特点是具有非常长的输入袢（Roux 袢）和较短的共同通道。本研究分析了前 355 例接受新型远端超长 Roux-en-Y 胃旁路术（DVLRYGB）患者的 5 年随访数据（并发症发生率、减重效果、营养代谢变化）。所有患者（平均年龄 41.4 ± 10.8 岁，BMI 48.5 ± 11.5 kg/m²）均接受了腹腔镜手术，总体随访率为 98.9%，平均随访时间为 1.6 ± 1.4 年。结果显示，共同通道长度为 76 ± 7 cm，胆胰支长度为 79 ± 14 cm，输入袢（Roux 袢）长度为 604 ± 99 cm。术后 3、4 和 5 年的平均超重体重减轻率（EWL）>74%，定义为 EWL<50%的手术失败率仍<6%。每年的血液检测结果表明，严重营养缺乏的发生率相对较低，但轻度贫血和低蛋白血症较为常见。4 例（1.1%）患者需要进行腹腔镜下吻合口近端化修复术。数据表明，我们的 DVLRYGB 可获得理想的减重效果，并且在结构化的多学科随访计划下，严重营养不良的发生率相对较低。
